The presence of meconium in urine reflects some form of communication between the urinary tract and rectum, and suggests a high type of anorectal malformation. Such patients require a diveing colostomy. The colostomy decompresses the bowel and provides protection during the healing of subsequent repair. Posterior Saggital Anorectoplasty (PSARP) is performed after 4-8 weeks. The presence of meconium in urine and a flat bottom are considered indications of a protective colostomy.